SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 36 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission C ON S E N T I NG F OR E R C P Obtaining a patient’s consent for ERCP is the job of the doctor carrying out the procedure, or someone who is familiar with ERCP but who may not be carrying out the procedure on the day, for example the registrar. The purpose of the consent process is to ensure that the benefits and risks inherent to the procedure are explained to the patient in advance, so they can make a decision with the doctor to agree to have it done. It must be given voluntarily, the patient must have all the information necessary to make the decision, and have capacity (ie not be mentally impaired in any way) to process that information. The rules and laws around consent are complex and each hospital will have protocols concerning it, so I won’t go into detail here. The NHS website (www.nhs.uk ) has an excellent chapter on it, which I recommend. Many patients are also anxious about having a complex endoscopic procedure, and the consent process allows the opportunity for questions to be asked. Patients will have had a leaflet given to them prior to the ERCP explaining all the risks and potential for complications, but may still have questions whilst waiting for the procedure even after the consent form has been signed. Visualisation is a powerful tool in reducing anxiety. A member of the endoscopy staff who is familiar with ERCP and can describe what happens during the procedure is a valuable asset in helping reduce anxiety. A patient entering the endoscopy theatre who is calm and ready and has been reassured about what to expect is more likely to have a successful and better tolerated procedure. This topic will be covered in more detail in the chapter about sedation, but reassurance and help from well-informed staff before the procedure are extremely valuable. In the UK almost all ERCP’s are carried out under conscious sedation. This means that although the risks and complications are the same, much of the anxiety about the procedure arises from the knowledge that most patients will be aware of some sensation and even a degree of discomfort at some point during the procedure, which is not the case when deep sedation techniques (ie using Propofol) or general anaesthetic are used. 10